MEDICARE: IVAN KLAYMAN OD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV2786	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C08271	OTHER	NY	MEDICARE PECAN

General Provider Information

NPI Number	:	1285935056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVAN KLAYMAN OD PC

Provider Business Mailing Address
First Line	:	1146 DEER PARK AVE
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-3102
Country	:	US
Telephone Number	:	631-586-5055
Fax Number	:	631-274-3683

Provider Business Practice Location Address
First Line	:	1146 DEER PARK AVE
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-3102
Country	:	US
Telephone Number	:	631-586-5055
Fax Number	:	631-274-3683

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IVAN KLAYMAN
Credential	:	OD
Telephone Number	:	631-586-5055

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	11/10/2010

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